What is cholestasis?

Cholestasis is a condition that affects how your liver works during pregnancy. It typically causes itch without a rash. It’s uncommon and usually starts in the third trimester of pregnancy.

Terms used by healthcare professionals to describe cholestasis in pregnancy:

• obstetric cholestasis
• intrahepatic cholestasis of pregnancy

What are symptoms of cholestasis?

The main signs and symptoms of cholestasis are:

• itchy skin without a rash
• fatigue, nausea or abdominal discomfort
• blood tests that show problems with how your liver works

Itch often starts on the palms of hands and soles of feet, but it may affect other parts of your body. Your skin may appear yellow (jaundiced) as the condition progresses.

Both the itching and the liver issues go away after your baby is born.

What causes cholestasis?

It's not clear exactly what causes cholestasis, or why some people are affected. The condition sometimes runs in families.

People with cholestasis have problems with their liver. Substances known as bile acids and bilirubin build up in the blood. This is the likely cause of itchy skin.

When should I see my midwife or doctor?

See your midwife or doctor if you notice itchy skin without a rash after 20 weeks of pregnancy.

Tell your midwife or doctor if your itch is especially bad on your hands or feet, or if you (or a family member) have previously been diagnosed with cholestasis.

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How is cholestasis diagnosed?

Your midwife or doctor will diagnose you with cholestasis of pregnancy if your blood tests show that your liver function or bile acid levels are higher than normal for pregnancy. Your midwife or doctor will repeat the blood tests every week or 2 to monitor the condition if you have it.

If your bile acid levels are a little high but your liver tests are normal, your midwife or doctor may ask you to do another bile acid test after not eating for a while (fasting). These tests help your healthcare team know if your symptoms are because of cholestasis or something else.

How is cholestasis treated?

Cholestasis of pregnancy is usually treated with a medicine called ursodeoxycholic acid. This lowers bile acid levels and can help relieve your itchy skin. Your doctor will prescribe the medicine if you need it. You should start taking it right away and continue taking it until after your baby is born. Your doctor and pharmacist will give you more information about how to take this medication and when it’s safe to stop taking it.

Relieving the itch of cholestasis

You can try these soothing measures to relieve itch:

• Use moisturiser. Before using any creams, check with your pharmacist or healthcare team if they are safe in pregnancy.
• Stay cool and avoid hot showers.
• Wear loose clothing.
• Use a non-soap body wash.
• Avoid things that can worsen itch, such as rough fabrics, caffeine and alcohol.
• Antihistamines may also help, so ask your pharmacist for advice.

Will cholestasis affect my baby?

Cholestasis can increase the risk of fetal distress, preterm labour and stillbirth. If you have cholestasis, your baby is more likely to need to go to the neonatal intensive care unit (NICU). The higher your bile acid levels, the higher these risks are. For more information speak to your healthcare team about how this condition may affect you and your baby.

What are the complications of cholestasis?

If you’re pregnant and have cholestasis, you’ll be offered extra care from your healthcare team. Sometimes, doctors might suggest it's best for your baby to be born a bit earlier than usual. This is known as an induction of labour.

You will make decisions about your birth as part of a shared decision-making process between you and your doctor or midwife. Unless it is an emergency, your healthcare team will explain any intervention they recommend, as well as the risks and benefits to you and your baby, before you can give your informed consent.

If you have cholestasis of pregnancy, you and your baby will be offered extra blood tests and monitoring both during pregnancy and after birth.

Can cholestasis be prevented?

Because the exact cause of cholestasis of pregnancy is unknown, there is no known way to prevent it. If you notice symptoms of itchy palms or feet, were diagnosed with cholestasis in a previous pregnancy or have a close family member who was diagnosed with it, let your healthcare team know. This may help you get a timely diagnosis and treatment if you need it.

Resources and support

Visit the Australian College of Dermatology to read more on intrahepatic cholestasis of pregnancy, including causes and diagnosis.

The Royal Women’s Hospital has helpful information on common concerns in early pregnancy, including skin changes and itching.

If you are pregnant or breastfeeding and would like to find out more about your medicines, call Medicines Line on 1300 633 424.

Looking for information for Aboriginal and/or Torres Strait Islander people?

You can find out more about Aboriginal and/or Torres Strait Islander pregnancy health on Stronger Bubba Born or watch the How to Have a Safer Pregnancy video.

Do you prefer to read in languages other than English?

The Multicultural Centre for Women’s Health has a catalogue of health resources for women, available in more than 70 languages.